Scar Tissue

[Karlynn]

With the news of RandyL's valve problems with scar tissue I did some research on scar tissue and valve types. I was wondering if tissue valves also had problems associated with scar tissue growth. We have "talked" here about mechanicals needing to be replaced because of scar tissue, but haven't really addressed tissue valves needing to be replaced more quickly than expected due to scar tissue. We have talked about the problem of scar tissue in connection with reops once the valve begins to fail, but not as scar tissue as a cause of failure.

The info that I was able to find some information that, yes, tissue valves can fail prematurely due to scar tissue growth. To what extent, I was not able to find. One post I found was on the AHA boards. A young woman who's porcine valve implanted in 2/05 was needing to be replaced because of scar tissue causing the valve to fail and there were a few other Googled references addressing this issue.

My question, since it appears that failure due to scar tissue is a possibility for any valve type, are there blood tests, or other tests, that can be run to rule out some types of scar tissue issues? If there is, are these tests run as protocol for those approaching valve replacement. And if not, why not? Obviously, some types of scar tissue formation would not be able to be detected until after the fact, but if there are those that can be detected with simple tests, are they being done? And if one has a possibility of quick or excessive scar tissue growth, is one type of valve preferable to another?

 

[Lynlw]

I don't know what the answer is, but I've often wonderred if people that tend to make keloid scars (that you can see ) would make more scarring inside. Justin hasn't had any scarring issues so far w/ his valve, but it also isn't connected to his own tissue it is in the middle of a gortex conduit, BUT he has alwasy had a issue w/ keloid on his zipper, altho since it was cut 3 times, on the same spot that probaly has alot to do with it. as for the rest of his body some scars keloid and other don't. but he has big issues w/ building scars inside for him at least the concern for reops and scars has more to do w/ the fact that his heart was fused to his sternum w/ scar tissue, and it wasbad enough to put off his last surgery as long as possible, using caths and stents, until the benefits outweighed the risks.
he has alot of patching inside his heart and none of them have excessive scarring, he did have some problems w/ his origonal conduit, but that was due more to calcification than scarring,
but i do think it would be a good poll asking people if they tend to make keloid scars and if they have had issues w/ scarring inside or around their valves, lyn

 

[Karlynn]

Lyn, I form keloid scar tissue as well. And just like Justin, there doesn't seem to be any rhyme or reason to where it forms. In fact, 1/2 of my OHS incision is keloid, and 1/2 isn't. As far as the echos show, there doesn't appear to be any scar tissue encroaching on my valve.

I know there is something having to do with a protein component in the blood that makes people scar more quickly. This was kind of what I was thinking of in my question related to blood tests.

If someone does tend to produce more scar tissue than normal, that's not exactly something that can be stopped. I'm just wondering then what that means as far as valve choice? Is one better than another. Is the On-X with it's compents for blocking scar tissue from encroaching a better choice? Do tissue valves tend to scar less, so that would be a better choice.

Enquiring minds want to know.

 

[geebee]

I am not much of a keloid "former" but I have had a lot of problems with scar tissue ingrowth on my valve. I was diagnosed as having "anti-heart antibodies" associated with Dressler's syndrome after my first OHS. It resulted in so much scar tissue, my mechanical valve was sticking shut which is why I had the second OHS about 18 months later. I was then put on almost a year of steroid which seemed to slow things down.

It took another 12 years before I needed the valve "cleaned" again. That is when we implanted the St. Jude feeling that the 2 leaflet valve might be better than the single in preventing sticking due to scar tissue formation. I have not had any more problems and now they feel the scar tissue removed during my third OHS was formed prior and during the early stages of the steroid therapy. It just took a long time for the valve to start breaking off tissue, causing TIAs and the need for replacement. Also, the original valve I had (Bjork-Shiley) had been recalled so we thought, as long as we are in, get rid of it.

 

[RandyL]

Keep that research going Karilynn! I am still waiting to hear from my original surgeon to view the TEE films so he can give me his opinion of the test.

 

[Sandy SHields]

I am not much of a keloid "former" but I have had a lot of problems with scar tissue ingrowth on my valve. I was diagnosed as having "anti-heart antibodies" associated with Dressler's syndrome after my first OHS. It resulted in so much scar tissue, my mechanical valve was sticking shut which is why I had the second OHS about 18 months later. I was then put on almost a year of steroid which seemed to slow things down.

It took another 12 years before I needed the valve "cleaned" again. That is when we implanted the St. Jude feeling that the 2 leaflet valve might be better than the single in preventing sticking due to scar tissue formation. I have not had any more problems and now they feel the scar tissue removed during my third OHS was formed prior and during the early stages of the steroid therapy. It just took a long time for the valve to start breaking off tissue, causing TIAs and the need for replacement. Also, the original valve I had (Bjork-Shiley) had been recalled so we thought, as long as we are in, get rid of it.

Hi it's Sandy we have talked before. I just want to let you know that when I get to feeling sorry for myself all I have to do is read some of the stories that you all have in here and my problems aren't half as bad. Sounds as if you have really been worked over. I have had only one ohs and with the same valve bjork shiley back in 1983 and have had numerous letters about the recall. I haven't had any troubles like you and my cardiologist said not to worry about it until something happens. I am not sure what they have to do with the scar tissue removal or how did you know you had a problem? you are a tough person.

 

[geebee]

Hi it's Sandy we have talked before. I just want to let you know that when I get to feeling sorry for myself all I have to do is read some of the stories that you all have in here and my problems aren't half as bad. Sounds as if you have really been worked over. I have had only one ohs and with the same valve bjork shiley back in 1983 and have had numerous letters about the recall. I haven't had any troubles like you and my cardiologist said not to worry about it until something happens. I am not sure what they have to do with the scar tissue removal or how did you know you had a problem? you are a tough person.

Hi Sandy - good to hear from you again. Hope all is going well.

If you have a smaller BS valve, you really don't need to worry about the strut failure since most of them were in the larger sizes (around 29mm). The reason we replaced my BS was "just in case" and also because when the single disc of the BS stuck shut, it was a real problem.

As far as knowing about the scar tissue problem, when we went in for the second surgery, we did not actually know the problem was scar tissue. The tests seemed to indicate a clot on the valve and that's why the surgery was done so quickly after the tests indicated a problem. Once the surgeon was in, he found scar tissue all over the disc impeding the mechanics of the valve.

Thanks for the nice comment but I don't think I am any stronger than the next person. I just want to live so I guess "you just do what you gotta do". I just feel really lucky and so much better off than a lot of people.

 

[gijanet]

Karlynn.............

Karlynn.............

keep looking. I would be very interested in knowing more about that test. Katie's scar keloided this time - the bottom half - and she has never done that from her previous three surgeries. I just thought it was because her chest was not closed until two days post-op, but now you have me wondering...............and not in a good way.

Many hugs. J.